ABSTRACT
OBJECTIVE: Smoking prevalence is frequently estimated on the basis of self-reported smoking status. That can lead to an underestimation of smoking rates. The aim of this study was to evaluate the difference between self-reported smoking status and that determined through the use of objective measures of smoking at a pulmonary outpatient clinic. METHODS: This was a cross-sectional study involving 144 individuals: 51 asthma patients, 53 COPD patients, 20 current smokers, and 20 never-smokers. Smoking status was determined on the basis of self-reports obtained in interviews, as well as through tests of exhaled carbon monoxide (eCO) and urinary cotinine. RESULTS: All of the asthma patients and COPD patients declared they were not current smokers. In the COPD and asthma patients, the median urinary cotinine concentration was 167 ng/mL (range, 2-5,348 ng/mL) and 47 ng/mL (range, 5-2,735 ng/mL), respectively (p < 0.0001), whereas the median eCO level was 8 ppm (range, 0-31 ppm) and 5 ppm (range, 2-45 ppm), respectively (p < 0.05). In 40 (38%) of the patients with asthma or COPD (n = 104), there was disagreement between the self-reported smoking status and that determined on the basis of the urinary cotinine concentration, a concentration > 200 ng/mL being considered indicative of current smoking. In 48 (46%) of those 104 patients, the self-reported non-smoking status was refuted by an eCO level > 6 ppm, which is also considered indicative of current smoking. In 30 (29%) of the patients with asthma or COPD, the urinary cotinine concentration and the eCO level both belied the patient claims of not being current smokers. CONCLUSIONS: Our findings suggest that high proportions of smoking pulmonary patients with lung disease falsely declare themselves to be nonsmokers. The accurate classification of smoking status is pivotal to the treatment of lung diseases. Objective measures of smoking could be helpful in improving clinical management ...
OBJETIVO: O tabagismo autodeclarado é usado frequentemente para estimar a prevalência dessa condição. As taxas de tabagismo podem ser subestimadas por esse método. O objetivo deste estudo foi avaliar a diferença entre o tabagismo autodeclarado e o tabagismo determinado pelo uso de medidas objetivas em um ambulatório de doenças respiratórias. MÉTODOS: Estudo transversal realizado em 144 indivíduos: 51 pacientes com asma, 53 pacientes com DPOC, 20 fumantes e 20 não fumantes. O tabagismo foi determinado por meio de autorrelato em entrevistas e medição de monóxido de carbono no ar exalado (COex) e de cotinina urinária. RESULTADOS: Todos os pacientes com asma e DPOC declararam não ser fumantes. Nos pacientes com DPOC e asma, a mediana de concentração de cotinina urinária foi de 167 ng/ml (variação, 2-5.348) e de 47 ng/ml (variação, 5-2.735 ppm), respectivamente (p < 0,0001), enquanto . a mediana de COex foi de 8 ppm (variação, 0-31) e 5,0 ppm (variação, 2-45 ppm), respectivamente (p < 0,05). Em 40 (38%) dos pacientes com asma ou DPOC (n = 104), houve discordâncias entre o tabagismo autodeclarado e a concentração de cotinina urinária (> 200 ng/mL). Em 48 (46%) desses 104 pacientes, o não tabagismo autodeclarado foi refutado por um nível de COex > 6 ppm, considerado indicativo de fumo atual. Em 30 (29%) dos pacientes com asma ou DPOC, a concentração de cotinina urinária e o nível de COex contradisseram o autorrelato desses como não fumantes. CONCLUSÕES: Nossos achados sugerem que altas proporções de pacientes fumantes com doenças respiratórias declaram ser não fumantes. A classificação correta do tabagismo é fundamental no tratamento dessas doenças. Medidas objetivas do tabagismo podem ser úteis na melhora do manejo clínico e no aconselhamento. .
Subject(s)
Female , Humans , Male , Middle Aged , Asthma/epidemiology , Pulmonary Disease, Chronic Obstructive/epidemiology , Self Report , Smoking/epidemiology , Asthma/urine , Biomarkers/analysis , Brazil/epidemiology , Cross-Sectional Studies , Carbon Monoxide/analysis , Cotinine/urine , Prevalence , Pulmonary Disease, Chronic Obstructive/metabolism , Smoking/urineABSTRACT
La orinoterapia, parte de la medicina tradicional, se basa en la práctica de estilos de vida saludables y el uso de la propia orina para mejorar el estado de salud. Objetivo: determinar el efecto de la orinoterapia en el control de las manifestaciones clínicas del asma bronquial en niños de 4 a 11 años que asistieron al Centro de Retiro Holístico Anna Margottini (CRHAM) entre octubre de 2008 a enero de 2009. Material y métodos: enfoque cuantitativo, diseño ex post facto, basado en la recolección y descripción de datos obtenidos de 30 niños a los que se les aplicó el Child Asthma Control Test, antes y después de haber recibido orinoterapia. Resultados: antes de recibir orinoterapia, 19 de 30 niños (63,3 por ciento) no controlaban el asma bronquial y once controlaban el asma parcialmente. Contrario a esto, luego de recibir orinoterapia 24 de los 30 niños (80 por ciento) controlan su asma adecuadamente; seis de los niños (20 por ciento) controlan el asma parcialmente no quedando ningún niño en el nivel no controlado. Conclusión: al comparar el grado de control de las manifestaciones clínicas del asma bronquial antes y despues de recibir orinoterapia, se observa que el nivel de control del asma de los niños se ha incrementado con la aplicación del tratamiento. Sin embargo, la orinoterapia no radica en el uso exclusivo de la propia orina, sino también en la practica de estilos de vida saludables como el consumo de fitos, los cuales ya han demostrado su beneficio en el tratamiento del asma.
The urinotherapy part of traditional medicine is based on the practice of the healthy lifestyles and use their own urine to improve health status. Objective: To determine the effect of urinotherapy to control the clinical manifestations of bronchial asthma in children 4 to 11 years who attended the Center for Holistic Retreat Margottini Anna (CRHAM) between October 2008 and January 2009. Material and methods: Experimental design is not ex post facto, of a quantitative approach, since it was based on the collection and description of the data obtained from 30 children who were interviewed with the Child Asthma Control Test before and after receiving urinotherapy. Results: Before receiving urinotherapy 19 of 30 children (63.3 per cent) did not control the asthma and 11 partially controlled asthma. Contrary to this, it was noted that after receiving urinotherapy 24 of the 30 children (80 per cent) adequately control their asthma, 6 of all children (20 per cent) partially controlled asthma is not leaving any child in the uncontrolled level. Conclusion: By comparing the degree of control of the clinical manifestations of bronchial asthma before and after receiving urinotherapy is observed that the level of asthma control of children in this study increased with the treatment. However urinotherapy not only lies in the exclusive use of one's own urine, but also in the practice of healthy lifestyles such as consumption of phytosanitary of which has already demonstrated its benefit in the treatment of asthma.